The question was there to make people think, Hypercritical. Sometimes there is an obvious answer. Sometimes the evidence for the obvious answer is a little weak so it is best to leave things hanging in the air as a question. Sometimes the obvious answer may cause offence. Sometimes there is no answer or several answers. You will have to guess what I believe to be the case here. If I had wanted to spoon feed you I would have.

To stick more precisely to your words, there is no doubt that the problem would be solved if men/boys kept their trousers zipped up and did not view females as 'fair game' so clearly you have a solution. And, of course, your other solution which is making the men and boys aware of contraception then becomes superfluous.

I am sorry, Hypercritical, I thought you might be a troll rather than a genuine thinker. Trolls are best ignored but I thought I might try agreeing with you despite the fact there is a problem with one of your solutions. I am sure a troll wouldn't have conceded defeat!

Actually there is a problem with both of your solutions because the question related to contraception applies to the boys as much as to the girls. On reflection, the question should have been: why aren't young people in parts of Cameroon taught about contraception? The story was about girls rather than boys and parents' concerns are about girls becoming pregnant not boys which is why the question came out the way it did. I did not intend to imply that boys should not be taught about contraception. The problem is with lack of teaching to both sexes.

I know how you feel, Neelu. The video in this post on female circumcsion made my blood turn cold. I am quite glad it has gone from YouTube.

My first thought when you said that you could watch it was that you should and we should all then do what we can to stop these things but the comments to my post on female circumcision make it clear that it is not as simple as that. Things never are.

Practices like this one (nener heard of it before) or female mutilation, as I prefer to call it, exist in uneducated, poor societies. If you want the people to know better, put food on their table first, then you can educate them - same goes for the so called child labour, where we here in the spoilt west order people about thinking we're inproving their lives while we are in fact causing them more poverty and more suffering! Time the west grows up!

On another note, why do you think HyperCritical is a troll Dr Grumble?

I shouldn't have but I was a bit nonplussed by the apparent suggestion that we should try and keep the boys away from the girls and initially thought this must be a wind up. The other thing that perplexed me was the idea that this was the fault of boys which to me also seemed a wind up. Is it unnatural for boys to see girls as 'fair game'? And isn't it the case that even away from the western world young women go to great lengths to entice the interests of suitors? Even if HyperCritical is correct it didn't seem to me realistic to alter the behaviour of young men with regard to their approach to the opposite sex. And, as far as I know, nobody is suggesting that these women are raped so they do have some responsibility themselves. I didn't want to point all this out to HyperCritical whose very name implied that we might end up in a long battle - though that was not, in fact, intended.

Actually, Anonymouse, I think you are closer to the solution than either Dr G or HyperCritical. Except that finding food to put on their tables is not an easy problem to solve either.

As for child labour, I have had the same thoughts. It is better for a child to work than starve. When I was in Ethiopia we used to pay the locals generously (by their standards) but it resulted in local inflation which had its own problems. There are no quick fixes.

There's no easy answers as you say, Dr G. From our perspective, the mother is assaulting her child in a barbaric fashion; from her perspective she is protecting her child from pregnancy,HIV and early death.

I would favour education and changing the culture as the bulwark against stuff like this; that, and putting food on the table. One initiative which is in my view, simple but brilliant is 'Mary's Meals' a charity set up by Magnus Mc Farlane Barrow. It's basically school dinners. You contribute £5 (which is enough to feed a child for a year). They use the money to provide a meal of rice at the local school. The child has to attend school to get it. So they get an education, their parents have one less mouth to feed, it cuts down on child prostitution and as the produce is sourced locally, it also boosts the economy. Also, because it is sourced locally, it cuts out the problems with transport and distribution that you have with bigger initiatives.

I think that several solutions are needed to Africa. I would, for example, like to see at some point the setting up of a proper health insurance system in the likes of Cameroon or Malawi, but to do that needs certain prerequisites. The country needs to be at peace. You need a civil service. You need a tax base. And it's got to be borne in mind that they don't hold all the answers either. South Africa and Botswana are two relatively prosperous and peaceful countries. Both of them are in the top six for HIV; South Africa is sixth at 19% and Botswana is second at 30% prevalence(2005).Swaziland is first at 33%.(Cameroon is sixteenth at 5%). There needs to be an analysis of why this is the case. They are more urbanised of course; there is also a lot of coming and going with the mining industries common to these countries. If I was in charge in South Africa, I would be tempted to put up the shutters for a while and monitor long distance travel. But there's many threads to Africa's health problems and many solutions are required.

It is easy to misunderstand in the online world. The ease of publishing means the written word is like the spoken word without the all-important the extras that go with speech. Emoticons are said to help with this but I rarely use them. I am sure a ;-) would have helped in my first reply to you, Hypercritical. Anyway you are gracious as before and I think all this banter has moved our thinking forward on the topic in question.

"The name of the blog (since it changed its direction) is perhaps now not helpful "

Well, I have to say I do like the original name 'HyperCryptical' better cos HyperCritical implies that one is impossible to convince as they'll always find something to winge about, whereas 'HyperCryptical' is one who has enough capacity and vision to look at a subject from every possible direction, eh?

And the puzzles were not too bad either, nouvelle idea! Only they should come with clues for us poor mortal souls, hehe :-D

It is difficult for us to grasp the depths of the problems in some of these countries. I have visited remote hospitals in South Africa and worked in extremely remote 'hospitals' in Ethiopia. The problems seem intractable. When I went to Ethiopia there were only 374 doctors for a population of, then, about 32 million. Most of the doctors were foreign and in the three major towns. The professor of medicine in Addis Ababa, a Scot, gave us only one message and that was not to sleep with the women - this was before HIV was known about but even then the risks were high as what we at that time called venereal disease was rife. He then, wisely perhaps, said that if we did we should come and see him. The professor of obstetrics, Coralie Rendle-Short, told us that a brothel could be recognised by a white tin on a pole outside. To my astonishment, I found white tins so widespread that I wondered if I had misunderstood what they signified. Perhaps I had. I can find no confirmation on the web that a white can in Ethiopia has the same significance as a red light in other parts of the world.

But I have been able to confirm one of the other horrors I came across. I was told to look out for shiftas who would be out to cut off my genitals. I thought this was a wind up but unfortunately came across young men who had had their private parts lopped off. This was in a part of Ethiopia called Wallamo but it could be this unsavoury habit is widespread. I do wonder now if I dreamt this but I have found similar accounts on the web.

I never wondered why the people of Ethiopia couldn't do better for themselves. People who have not been to the remote areas I went to might think that all they need is tractors and know-how but I was just amazed that anybody could survive at all in some of the barren areas I came across. Certainly much of the terrain was not something modern farming could cope with.

I went to places that were 5 days mule trek from the nearest road. Education has little to offer people who live in such remote areas and when I came across seemingly quite well educated people in slightly less remote places it did not seen that their education had opened that many doors for them.

It would be great if Gordon Brown could put Africa to rights but I fear his chances are about as good as those of Tony Blair in the Middle East.

Anonymouse: we have bowed to your judgement and the name has returned to its original form. Oddly enough, it was often 'read' as hypercritical - as we do often see what we expect to see and don't see the whole picture!

Ethiopia is doing pretty well now, Africa speaking both on infant mortality and life expectancy. Average life expectancy is 53; this compares with Swaziland at 40 and there's 26 countries between the two of them. It has 86 deaths per 1000 per live birth; this compares with Sierra Leone at 160 per 1000 and there's 24 countries between them. You must have done something right, Dr G. I think Africa is going through the same process that Europe went through when all the statelets were organising themselves into countries from 1848 onwards. It's going to take time more than anything.

And why were you in pursuit of this information on the web Dr Grumble?___

Actually I was going to make a comment about how my Ethiopian patients are surprised when I speak to them in Amharic but, so far, fail to understand my Wallamo and while checking on the facts about the Wallamo tribe I came across a learned article that described one of the hospitals where I worked at the time that I was working in it along with the genital hunting habits of the local tribe. I decided that my linguistic skills were too identifying so let it drop - until now.

I have a very unsavoury tail to tell about what I witnessed with regard to the genital hunters and the attempts of the local police to track them down. It is a story which is probably best left untold.

I am quite surprised to learn from Julie that Ethiopia has moved on. (I wonder how reliable the data are.)It all seemed hopeless to me when I was there but Haile Selassie had not long been deposed and there was a war on. The local medical education was under threat with the local medical students being sent out to remote villages. That was the threat anyway.

From time to time, I think of throwing in the towel with the NHS and going back. You can do a lot of good in a country like Ethiopia. Most of the people are young and most have eminently curable conditions which is nice.

The info is from 2008 Pocket World Book of Statistics by the Economist. Data gathering is pretty difficult in these areas, but Bob Geldof did do a visit to Ethiopia about three years ago and it looked very green and beautiful, so I think they're right. Now that America and Russia aren't fighting proxy wars all over Africa I think it's had a chance to recover.

Ethiopia is a big place. Much depends on where you are and the season. The day I arrived it was like a beautiful English summer's day. It was exactly the same for three months and it didn't rain once. If you go down into the Danakil depression it is stiflingly hot. Nothing grows and the ground is made of salt. The locals cut the salt into blocks and them take them on camels up to Merkele in the highlands. I watched this being done in a way that cannot have changed much since biblical times. I doubt the subsistence farming has changed much either. If things have moved on it is a great achievement but I would be surprised if much has changed despite the efforts of Bob who clearly knows what he is talking about. As far as I remember Ethiopia essentially only had two all weather roads when I was there so most of the population was cut off from the modern world. And if there have been improvements in life expectancy it is surprising they haven't been offset by the ravages of HIV though perhaps some populations have been protected by their remoteness.

Of course wars are terrible for healthcare and survival generally. If the conflicts are over things might be much better than they were. Ethiopia has also been beset by recurrent famines of biblical proportions. These date back to biblical times and from what I saw seem to me to be unpreventable. The people live from harvest to harvest so if the rains fail it is a disaster. The last famine was a while ago so people would be living a bit longer from that alone.

My abiding memory of Ethiopia is that it was like going back in time and I certainly felt that many of the people I lived among were living much as the their ancestors had been living for thousands of years.

My abiding memory of Ethiopia is that it was like going back in time and I certainly felt that many of the people I lived among were living much as the their ancestors had been living for thousands of years.-------

You are making me wanting to go Dr Grumble - it sounds like a beautiful country, and it looks like it has lots of potential but that's lost because of poverty. Btw, I think Gordon Brown can and will make a difference for Africa. Him and what's his name are not the same cattle of fish, I trust in Gordon, he's an honourable man.

You did good going there, how long did you stay, if you don't mind me asking, and how well do you speak the language? :-)

You've made me pick up that Pocket World book again. It's totally addictive.

Believe it or not, Ethiopia isn't listed for HIV in it. That's cos its rate is 2% at the moment. I think that's for several reasons; geography, where it's up on that big plain, a large Muslim population who use circumcision and I'm not sure if the Ethiopian Christians there also use circumcision, but they are very close to ancient Judaic practice. There is also an enclave of Jews there who were airlifted to Israel during the '84 famine. There's a wonderful book (which is probably a load of hokum) which alleges that the Ark of the Covenant was taken there during a period of persecution in Israel and that is why the Jews are there as well. I do know that there is a church there where they claim to have the Ark in possession.

Doctor wise, they don't appear to be doing much better than when you were there. There's one doctor per 33 000 of population; that works out at around 2400 doctors. But maybe that'll improve. What this has made me reflect on is how important older people are in a community and how important teachers are. If they can live a bit longer and build up enough doctors to start running medical schools, they'll be able to increase the number of doctors rapidly. But it's slowly, slowly just now.

Right, don't you go running off to Ethiopia now, Dr G. You've got a blog to run here..

I was in Ethiopia for about three months, Sam, which is not long enough to learn much in the way of the language especially since the professionals spoke to each other in English. The other problem was that there are hundreds of different languages in Ethiopia. If you travel a short distance the people look different and speak a different language. I worked in three or four different places all with different languages.

As for the Ark of the Covenant, the Christians in Ethiopia date back to the beginning of Christianity and there were certainly rumours that the Ark is still there somewhere. I seem to remember somebody claiming that it was on an island in Lake Tana, the origin of the Blue Nile.

I can't remember now whether the Christians were mostly circumcised or not. I don't remember noticing that they were. I do remember burns on their skin made by witch doctors which I recognise now in immigrants from Ethiopia though they puzzle my staff. And many of them had had their uvulas removed too.

If you ever go to Ethiopia take a trip to Lalibela. It is very much on the tripper trail but when I went there, because there was a war on, I was the only foreigner around. It is a remarkable place. Google it.

Dear Dr GrumbleI'm a niece of Prof Rendle-Short (who you mention above). I am currently doing research on her with the intention of writing something about that timeframe and what she did - she was a very interesting woman. I've just visited Addis Ababa in order to find about a bit more of what things are like now and what her time then would have been like (1964 - 1975). I'd love to get in touch on the off chance that you remember her and have any anecdotes. jrendleshort at gmail.comThanks in advance Johanna Rendle-Short